tbuckley/cabot-search huggingface dataset:
Abstract 13394: Primary Perfusion Balloon Angioplasty in Primary Percutaneous Coronary Intervention for St-Segment Elevation Myocardial Infarction - The Novel Cardioprotective Revascularization Strategy
Authors: Toru Nakanishi, Dan Koto, Mizuho Kasahara, Kei Mizukoshi, Makoto Takano, Koichi Mizuno, Hisao Matsuda, Yoshihiro J Akashi
Journal: Circulation (2022)

Background: In patients with STEMI, primary PCI reduces the risk of cardiovascular death, whereases following myocardial reperfusion injury indicating poor prognosis. Post-conditioning is expected to limit reperfusion infarction but the long-term outcome is unclear. We investigated whether primary perfusion balloon angioplasty (PPBA) strategy might reduce reperfusion injury and improve prognosis. Methods: PPBA is maneuver treating as primary revascularization procedure with perfusion balloon angioplasty undergoing long-inflation (5-minutes or more) as post-conditioning. This study is a retrospective analysis from an observational registry which enrolled all consecutive 49 patients with STEMI undergoing PCI in PPBA strategy or conventional balloon angioplasty (CBA) strategy at a single center from February 2021 to January 2022. The primary outcome of the study was MACE as a composite of all-cause death, cardiac death, MI, CI-TVR, hospitalization because of heart failure, and cerebrovascular disease followed at 6 months. The secondary outcome was the composite of no-reflow or slow flow phenomenon, ST elevation, and VT or VF occurrence immediately after primary revascularization procedure. Results: 24 patients were treated with PPBA strategy and 25 patients were treated with CBA strategy. At the 6-months, primary composite outcome occurred in 25% treated with PPBA strategy and in 52% treated with CBA strategy (HR, 0.38; P=0.04); the difference was driven by a lower incidence of cardiac death, MI, CI-TVR in PPBA arm. Immediately after primary revascularization, secondary composite outcome occurred in 4.2% treated with PPBA and in 56% treated with CBA (RR, 0.03; P=0.0001); the difference was driven by a lower incidence of no-reflow/slow flow and ST elevation in PPBA arm. Conclusions: PPBA strategy as primary cardioprotective revascularization expected post-conditioning reduces lethal reperfusion injury, resulting in a better prognosis in STEMI.
Abstract 13549: Plasma Metabolomics Identify Major Differences in Symptoms and Quality of Life Among Patients With Heart Failure
Authors: Corrine Y Jurgens, Christopher S Lee, Kenneth M Faulkner, David E Lanfear
Journal: Circulation (2022)

BACKGROUND: Plasma metabolites predict survival among patients with heart failure (HF), but symptom burden is critical, underpinning functional status and quality of life (QOL). The relationship of plasma metabolome and symptom or QOL phenotypes is not established. AIM: We conducted a latent class analysis to identify plasma metabolite patterns in relation to symptoms and QOL among HF patients. METHOD: A prospective HF registry collected baseline plasma for metabolomics and health status. A total of 13 metabolites (organic acids, amino acids, acylcarnitines) previously shown to predict survival were used in analyses. QOL and symptoms were quantified using the Kansas City Cardiomyopathy Questionnaire. Distinct metabolite patterns were identified using latent class mixture modeling. Linear regression tested the association of metabolite profile with QOL and total symptom scores controlling for age, gender, and NYHA class. One-way ANOVA characterized group differences. Results: A total of 1192 patient participants had complete metabolite and health status data for analysis. Among these patients, 62% were male, 48.5% self-identified as African-American and average age was 68 years (± 12). The majority (58%) were non-ischemic, 56% were NYHA Class I and comorbid conditions were common (90% hypertension, 72% hyperlipidemia, 43% diabetes). Three metabolite latent profiles (MLPs) were identified. MLP 1 had significantly higher NT-proBNP, worse functional class (72% NYHA 3-4) and lower ejection fractions (0.30 vs 0.35) compared with MLP 2 and 3. MLP class predicted symptoms (R 2 =0.39, F(7,1182)=F 107, p=0.006) and total QOL scores (R 2 =0.31, F(7, 1182)=F77.3, p=&lt;0.001) controlling for age, gender and NYHA class. The magnitude of difference was high; among MLP 2 and 3 compared to MLP1, total symptom scores ranged 7-9 points better and QOL 12-15 points better. No differences in age, gender or race were found across MLPs. Conclusion: Three latent metabolite profiles were identified that independently associated with significant differences in symptoms and QOL. Considering a minimal clinically important difference in KCCQ scores is 5 points, our results demonstrated large differences in patient reported outcomes related to plasma metabolite profile.
Abstract 149: Epinephrine Administration First Versus Advanced Airway Management First For Adult Patients With Out-of-hospital Cardiac Arrest
Authors: Masashi Okubo, Sho Komukai, Junichi Izawa, Tasuku Matsuyama, Kosuke Kiyohara, Taku Iwami, Tetsuhisa Kitamura
Journal: Circulation (2022)

Introduction: Epinephrine administration and advanced airway management (AAM: ie, endotracheal intubation and supraglottic airway placement) have been commonly used for patients with out-of-hospital cardiac arrest (OHCA). However, the optimal sequence of these interventions remains unclear. We, therefore, compared epinephrine administration 1 st strategy with AAM 1 st strategy. Methods: We conducted a secondary analysis of a prospective, nationwide, population-based OHCA registry in Japan. We included emergency medical services (EMS)-treated adult (≥18 years) OHCA from 2014 through 2019, stratified into shockable or nonshockable rhythms. We excluded those who did not receive epinephrine or AAM. The primary outcome was 1-month survival and the secondary outcome was 1-month survival with favorable functional status, defined as a Cerebral Performance Category scale 1 or 2. To account for treatment selection bias between patients who received epinephrine before AAM and patients who received AAM before epinephrine, we calculated propensity score and used inverse probability treatment weighting analyses. Results: We included 8,854 patients with shockable and 79,687 patients with nonshockable rhythm. 1,825 patients (20.6%) of shockable rhythms and 11,769 patients (14.8%) of nonshockable rhythm received epinephrine before AAM. Among patients with shockable rhythm, epinephrine administration before AAM was associated with lower odds of 1-month survival (Odds ratio [OR] 0.83, 95% confidence interval [CI] 0.76 to 0.90) but not associated with favorable functional outcome (OR 0.94, 95% CI 0.82 to 1.70). Among patients with nonshockable rhythm, epinephrine administration before AAM was not associated with 1-month survival (OR 0.96, 95% CI 0.91 to 1.01) but was associated with higher odds of favorable functional status (OR 1.15, 95% CI 1.002 to 1.33). Conclusions: In this observational study, we found that epinephrine administration before AAM was associated with lower odds of 1-month survival among shockable rhythm but was associated with higher odds of 1-month survival with favorable functional status among nonshockable rhythm, suggesting that the optimal sequence of epinephrine administration and AAM may vary between initial rhythms.
Abstract 13281: In vivo Reprogramming of Mouse Fibroblasts Into Cardiac Progenitor Cells for Myocardial Infarction Treatment
Authors: Jialiang Liang, Yi-gang Wang
Journal: Circulation (2022)

Introduction: Our previous study demonstrated that fibroblasts can be reprogrammed into induced cardiovascular progenitor cells (iCPCs) by a CRISPR activation approach. However, it is still unknown whether in vivo iCPC reprogramming can be achieved by direct activation of endogenous genes. Hypothesis: Direct activation of endogenous loci by using CRISPR tools targeting genomic DNA can fulfill in vivo iCPC reprogramming to repair infarcted hearts. Methods: A new fibroblast-specific CRISPRa model (Col1a2-cre/ERT;CAG-cas9) was generated. SgRNAs targeting the core promoter region of Gata4, Isl1, Nkx2-5, Baf60c, or Tbx5 were locally introduced through an AAV system in MI mice that were created by permanent LAD ligation. Heart function was measured by echocardiography and tissue sections were harvested for immunostaining. Cardiovascular cells derived from iCPCs were determined by immunostaining, ex vivo characterization, and electrophysiological assay. Results: The CRISPR system was activated in ~50% of fibroblasts after tamoxifen induction. The lineage conversion into iCPCs was identified by the Nkx2.5-eGFP reporter. eGFP+ cells were expressing proliferative markers (Ki67 and Pcna) and aggregated into spheres during suspension culture after sorting. Progenitor markers (Flk1, Ssea1, and Pdgf-α) were co-expressed in eGPF+ cells. The ejection fraction and scar formation of infarcted hearts were improved after injection of sgRNA-AAVs for 4 weeks. The engrafted iCPCs were identified by the lineage-tracing reporter and differentiated into cTnT+ cardiomyocytes, α-SMA+ smooth muscle cells, or CD31+ endothelial cells in infarcted hearts. Conclusions: Activation of endogenous loci enables in vivo iCPC reprogramming for cardiac regenerative medicine.
Abstract 13583: Conduction System Pacing Experience: His Bundle vs. Left Bundle Branch Area Pacing at Columbia University
Authors: Michael Lavelle, Hirad Yarmohammadi, Carmine Sorbera, Frederick Ehlert, Angelo B Biviano, Hasan Garan, Elaine Y Wan
Journal: Circulation (2022)

Introduction: Conduction system pacing (CSP) with His bundle pacing (HBP) and left bundle branch area pacing (LBBAP) are utilized as alternatives to RV endocardial and biventricular pacing. Which patients gain the most benefit from CSP remains an area of active investigation. Objective: To report on the early experience with HBP and LBBAP conduction system pacing at an academic medical center. Methods: All patients with a Medtronic 3830 SelectSecure lead implanted from 3/2016 to 5/2022 at Columbia University were selected for chart review. Patients were excluded if follow up interrogation or clinical data were unavailable for review. Results: A total of 36 patients were included and 3 were excluded for lack of follow up. 25 patients had HBP and 11 patients had LBBAP (Table 1). Average time from implant to most recent interrogation for HBP was 530.8 ± 506.2 days, range 22 - 1589, compared to 113.6 ± 149.6 days, range 10 - 397, for LBBAP. The implant threshold was significantly higher in HBP compared to LBBAP (1.58 ± 1.06 V vs. 0.57 ± 0.19 V, p=0.004) (Table 1). There were increased threshold in both groups at follow up compared to initial implant HBP (1.81 ± 1.19 V vs 1.58 ± 1.06, p=0.17) and LLBAP (&lt; 30 days of follow up [n=4], 0.84 ± 0.66 V vs 0.58 ± 0.22 V,p=0.46; &gt;30 days of follow up [n = 7], 1.34 ± 1.40 vs 0.57 ± 0.19, p=0.18) although it was not significant. Complication rates were low, one HBP lead was deactivated due to high threshold, two LBBAP patients required lead revision, one for dislodgement and one for pocket infection. Conclusions: CSP is a feasible and safe procedure. Higher thresholds were observed in the HBP group at implant compared to the LBBAP group. There was a trend of an increased threshold over time in both groups. Ongoing monitoring of the LBBAP is crucial for long term feasibility.
Abstract 14090: Measures of Discrepancy Between Cystatin C and Creatinine Are Associated With Body Composition in the General Population and in Heart Failure
Authors: Lorenzo Braghieri, Austin S Nguonly, Alberto Pinsino, Maan Fares, Gabriel T Sayer, Nir Uriel, Ryan T Demmer, Paolo C Colombo, Melana Yuzefpolskaya
Journal: Circulation (2022)

Background: Sarcopenia is associated with disability and mortality. Coexistence of sarcopenia and obesity (sarcopenic obesity) relates to particularly poor outcomes. The prevalence of sarcopenia is increased in heart failure (HF) up to ~50%. Dual-energy x-ray absorptiometry (DXA) is the gold standard for body composition assessment but is limited by cost and radiation exposure. We studied whether the relationship between two renal biomarkers (ie, serum creatinine (sCr) - muscle mass dependent, and cystatin C (CysC) - muscle mass independent) could be used to reliably estimate body composition in the general population and in HF. Methods: We included National Health and Nutritional Examination Surveys participants who underwent DXA between 1999 and 2002. Multivariable linear models assessed the association between sCr/CysC and CysC- and sCr-based estimated glomerular filtration rate difference (eGFRdiff) with DXA-derived appendicular skeletal muscle index (ASMI m 2 ) and total body fat percentage (TBF%). Sample weights were used to account for complex survey design to ensure that estimates were representative of the general US population. Results: Among 3280 participants (44±22.9yo,49%F,190 with HF), 440, 1241, and 359 met criteria for sarcopenia, obesity and sarcopenic obesity. Overall and in HF, mean ASMI and TBF% were 7.4m 2 and 32.5% and 7.0m 2 and 36.9%, respectively. Overall and in HF, higher sCr/CysC and eGFRdiff were associated with increased ASMI and decreased TBF% ( Table ). sCr/CysC was the lowest in patients with lowest ASMI tertile (&lt;6.26 m 2 ) and highest TBF% tertile (&gt;40.3%) ( Fig ). A similar pattern was also seen in HF. Conclusions: Measures of discrepancy between sCr and CysC are strongly associated with gold-standard measures of body composition both in the general and HF populations. This biomarker approach is easy and inexpensive, allowing clinicians new opportunities for timely recognition and possibly early treatment of sarcopenic obesity.
Abstract 13758: Distension of the Upright Ultrasound Jugular Venous Pulse is Predictive of All-Cause Mortality in Patients Referred for Right Heart Catheterization
Authors: Thomas George, Maranda Herner, Elizabeth Dranow, Lillian KHOR, McHale Anderson, Alexander Zheutlin, Jonathan D Harrison, Elizabeth Wendl, Libo Wang
Journal: Circulation (2022)

Introduction: Bedside central venous pressure assessment is integral to diagnosing and managing heart failure (HF). A noninvasive point of care ultrasound (POCUS) assessment of the jugular venous pressure (uJVP) was validated as accurate in predicting elevated right atrial pressure (RAP) on right heart catheterization (RHC) in HF patients. A qualitative assessment of uJVP in the upright position (uuJVP) was found to be highly specific for detecting elevated RAP. We compared the prognostic value of the distended uuJVP and elevated RAP in predicting one-year mortality. Hypothesis: We hypothesized that a distended uuJVP was predictive of all-cause mortality. Methods: Adult patients undergoing RHC underwent uuJVP assessment with POCUS. A distended uuJVP was defined as internal jugular venous distention to at least the same size as the adjacent common carotid artery during resting inspiration and expiration (Figure 1c). Patients were examined upright at 90 degrees with their back/neck supported, and followed for one year after undergoing same day uuJVP assessment and RHC. Elevated RAP was defined as ≥10 mmHg on RHC. Kaplan Maier analysis of all-cause mortality was performed. Results: 100 patients had a uuJVP assessment prior to RHC. The distended uuJVP correlated with a mean RAP of 15 mmhg (8.3-17.1 mmHg) (Figure 1d) with a specificity of 94.6% for predicting RAP of ≥10 mmHg. Multivariate cox regression analysis showed that patients with a distended uuJVP had an increased one-year mortality (HR 3.20, 95% [CI 1.24- 8.20], p=.02) similar to those with RAP ≥10 mmHg by RHC (HR 3.21, 95% CI [1.20-8.64], p=.02) (Figure 1a/1b). Of 27 deaths, 11 (40.7%) had positive uuJVP with a specificity of 79.7%, 95% CI (69.2%-88%). Conclusions: The bedside distended uuJVP was similarly predictive of all-cause one-year mortality as elevated RAP by RHC. The clinical application of this simple, qualitative ultrasound estimate of RAP warrants further investigation.
Abstract 13866: Interventional Heart Failure: Current State of the Field
Authors: Miguel Alvarez, Nikolaos Diakos, Ian Larson, Mohammad Hashim Mustehsan, Navin K Kapur
Journal: Circulation (2022)

Introduction: The expanding intersection between interventional cardiology (IC) and advanced heart failure (AHF) has raised interest in an Interventional Heart Failure (IHF) specialty. Methods: We conducted a survey among cardiologists trained in AHF and IC to investigate the state of this new field. This was distributed by the Society of Cardiovascular Angiography and Interventions (SCAI) via their newsletter and publicized via Twitter. Results: Data from 55 respondents in 47 medical centers (22% outside the United States) was acquired. In the US, these centers are concentrated in the South (43%) and Northeast (23%), and commonly host advanced therapies programs: 89% ECMO, 69% durable LVAD and 56% heart transplant. Respondents were 94% men; 47% were 35-45 y. and 41% were &amp;gt45y. old. Foreign physicians accounted for 13%. In the US, 56% of respondents were international medical graduates (IMGs) and 31% were American medical graduates (AMGs). Most completed training after 2013 (69%). IC fellowship was completed first by 47% of AMGs, 50% of IMGs (Figure). Only 23% trained beyond AHF and IC. Area of clinical focus is coronary artery disease (CAD) 42%, cardiogenic shock (CS) 40%, structural procedures 13%. Respondents regularly implant IABP (95%), Impella (83%) and VA-ECMO (69%). Time devoted to IC is 50-80% in 49% (Figure). Most take STEMI call (84%) and do CCU rounds (95%) while only 21% take donor call. Only 32% feel their training was excessive and 82% would repeat it. Most (84%) support the creation of integrated 2-year AHF and IC fellowships. Conclusions: We report the first survey assessing the IHF specialty. We observed a growing workforce focused on CAD, mechanical circulatory support and CS. Development of integrated training pathways is viewed favorably by the IHF community.
Abstract 12787: Microrna Administration Attenuates the Contraction Deterioration of Microrna-1 Deficient Heart But Not the Susceptibility of Arrhythmia
Authors: Dandan Yang, Xiaoping Wan, Neill Schwieterman, Ege Kacira, Xianyao Xu, Omer Cavus, Tithi Shah, Feng Tang, Kenneth R Laurita, Loren E Wold, Thomas J Hund, Peter J Mohler, Isabelle Deschenes, Jidong Fu
Journal: Circulation (2022)

Introduction: Aged people are much more likely to suffer arrhythmias or develop heart failure. MicroRNA-1 (miR1), encode by two distinct genes in the mammalian genome, is an evolutionarily conserved, striated muscle-enriched microRNA with a critical role in regulating cardiac physiology. Full knockout of miR1 in mice causes postnatal lethal. Interestingly, miR1 expression was significantly decreased to the level of 12.5±4.0% in the heart of 18-month aged animals, in comparison with that in young mice (age 3-4 months). Aims: We hypothesize that miR1 deficiency is one of the major etiologies in diseased and/or aged hearts and study the therapeutic effect of miR1 administration. Methods and Results: We generated miR1-75% knockdown (75%KD) mice and confirmed that miR1 expression was 4-5 fold lower in 75%KD hearts than in WT hearts. Echocardiogram showed that 75%KD mice demonstrated impaired cardiac contractile function, evidenced by decreased ejection fraction, and fraction shortening. Surface ECG recording showed that 75%KD mice had significantly lower heart rates, shorter PR interval, prolonged QRS interval as well as premature ventricular contractions. Consistently, optical mapping of ex vivo hearts revealed that 75%KD hearts had slower ventricular conduction velocity. Whole transcriptome RNA-sequencing and Proteomic assays demonstrated cardiac electrical and metabolic remodeling in miR1-deficient hearts. Compared to WT cells, 75%KD ventricular cardiomyocytes showed more hyperpolarized RMPs with prolonged APD; the sarcomere shortening was significantly decreased at a 5Hz fast pacing rate. Structurally, 75%KD myocytes had disrupted mitochondria with a shorter length of sarcomeres. We delivered miR into the animals through intravenous tail vein injection and found that 12-week miR1 administration could significantly attenuate the decrease of ejection fraction of 75%KD hearts, however, miR1-treated hearts had significantly higher inducibility of arrhythmia than control-RNA treated hearts. Conclusions: MicroRNA-1 deficiency causes cardiac electrical and metabolic remodeling. Restoring miR1 prevents the contraction deterioration of miR1-deficient hearts but increases the risk of arrhythmia.
Abstract 13374: Effect of Moderate to Strenuous Exercise on Biological Aging as Determined by Artificial-Enabled Electrocardiography
Authors: Nazanin Rajai, Betsy Medina-Inojosa, Mohammad Ali Sheffeh, Abraham Baez Suarez, Mark A Nyman, Zachi Attia, Lilach O Lerman, Jose R Medina-Inojosa, Francisco Lopez-Jimenez, Amir Lerman
Journal: Circulation (2022)

Introduction: The physiological changes associated with aging have deleterious effects on cardiovascular function. In addition, increasing evidence showed the effect of exercise on improving cardiovascular health and reducing the aging process. The present study sought to demonstrate the association between exercise and biological age, estimated by our previously reported method using artificial intelligence-enabled electrocardiography (ECG). Methods: This retrospective observational study enrolled adults aged ≥18 years who have been evaluated at Mayo Clinic between 2019-2022 and completed the exercise questionnaire. The total time spent in moderate to strenuous exercise was calculated by multiplying the number of days engaging in exercise per week by the average minutes per day. The biological age was determined by applying our previously developed convolutional neural network model on the 12-lead ECG records (AI-ECG). The ECG records were within one year of subjects’ visits (in case of multiple visits, the closest one to the questionnaire was chosen). Positive Age-Gap (AI-ECG minus chronological age) reflects a person identified as being older by AI-ECG compared to his/her chronological age. Results: A total of 268,002 subjects (51% female) were recruited (mean age 59.7±16.4 years). Of those, 25.7% were not engaged in any exercise. The median day of engaging in exercise was 3 (Interquartile range, 2,5) per week, and the average time of exercising was 31.3±30 minutes/day. Age-Gap diminished progressively with increased duration of moderate to strenuous exercise (Figure 1). Linear regression analysis revealed exercise is an independent predictor of Age-Gap, (β= -0.043, 95%CI, -0.045 and -0.041, p&lt;0.001). Conclusions: Engaging in moderate to strenuous exercise is associated with slower biological aging relative to chronological age as determined by AI-enabled ECG.